IPhO VIP Case Competition 2018-2019 Entry Form
Please Select Your Chapter *
If you selected "other", please enter your chapter name (if not, please leave blank)
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Name of Primary Chapter Representative (Will be used to relay communications) *
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Email of Primary Chapter Representative *
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Name of Back-up Chapter Representative (Will be used to relay communications) *
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Email of Back-up Chapter Representative *
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Did you participate in last year's competition? *
I hereby certify that our IPhO Chapter is in compliance with all national requirements (E-board National Membership Requirements, Annual Report Score > 10) *
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